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Introduction and importance: Chylous peritonitis is characterized by a sudden accumulation of chyle in the peritoneal cavity, leading to symptoms of an acute abdomen. This condition is quite rare, with less than 100 cases documented in the medical literature, and is often misdiagnosed. Case presentation: The authors present a case of an acute abdomen in a young man who was initially suspected to have a perforated peptic ulcer. After laparotomy, the diagnosis of chylous peritonitis was confirmed. Despite extensive investigations, no underlying cause was identified. Treatment involved peritoneal lavage and placement of a pelvic drainage tube, with discharge after three days on a low-fat. Clinical discussion: Chylous peritonitis is a relatively rare condition, occurring in ~1 in 20 000 individuals. Chyle leakage can be detected through various diagnostic modalities including ultrasound, computed tomography, laparoscopy, or exploratory laparotomy. In cases where a definitive etiology is not identified, treatment typically involves peritoneal lavage and drainage. Postoperative management focuses on a low-fat diet and somatostatin administration to prevent recurrence. Conclusion: The present case highlights the importance of considering primary chylous peritonitis as a potential cause of acute abdomen in young patients. Future research should focus on identifying risk factors and establishing evidence-based guidelines for approaching this condition.
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This study assesses the prevalence and determinants of inadequate (less than eight contacts) and late antenatal care (ANC) initiation (starting after 12 weeks) among mothers delivered at Gadarif Maternity Hospital in eastern Sudan. A hospital-based cross-sectional study was conducted at Gadarif Maternity Hospital. A questionnaire was used to collect sociodemographic, clinical, and obstetric data through face-to-face interviews. Seven hundred mothers were enrolled with the median (interquartile range) of mothers' age, and parity was 28(24-32) years and 3(2-5), respectively. Of these 700 mothers, 79.3 percent and 10.3 percent had inadequate and late ANC, respectively. In multivariable logistic regression analysis, being a housewife (adjusted odds ratio [AOR] 1.93, 95 percent CI 1.09, 3.43) was associated with inadequate ANC. High parity (AOR 1.27, 95 percent CI 1.07-1.52) was positively associated with late ANC initiation. There was no association between age, residence, education, preexisting medical disorder, and history of miscarriage) with inadequate or late ANC initiation In eastern Sudan, four out of five mothers did not comply with the World Health Organization's recommendation of a minimum of eight ANC contacts for positive pregnancy outcomes. This study is crucial for policy-makers to take further strategic actions to ensure adequate and early ANC initiation for all mothers in Sudan.
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Madres , Paridad , Atención Prenatal , Humanos , Femenino , Estudios Transversales , Sudán/epidemiología , Adulto , Atención Prenatal/estadística & datos numéricos , Embarazo , Madres/estadística & datos numéricos , Adulto Joven , Encuestas y Cuestionarios , Factores Socioeconómicos , Aceptación de la Atención de Salud/estadística & datos numéricos , Factores Sociodemográficos , Modelos Logísticos , Prevalencia , Conocimientos, Actitudes y Práctica en Salud , Maternidades/estadística & datos numéricosRESUMEN
Hammam Faraun (HF) geothermal site in Egypt shows potential for addressing energy demand and fossil fuel shortages. This study utilizes abandoned oil well logs, seismic data, and surface geology to assess HF geothermal energy resources. Seismic interpretation identified a significant clysmic fault parallel to Hammam Faraun fault (HFF), named CLB fault. The two faults together create a renewable geothermal cycle through circulation of mixed formation-sea waters. Petrophysics revealed two main geothermal reservoirs: the Nubian sandstone reservoir and the Eocene Thebes carbonate reservoir with water saturation values approaching 100 %. Corrected borehole temperatures indicated reservoir temperatures around 120 °C and 140 °C for the Thebes and Nubian reservoirs, respectively. Fracture analysis and stress state provided insights into subsurface fractures. A geomechanical model demonstrated the impact of different stresses and pore pressure on geothermal fluid flow. NE-SW oriented fractures showed a higher dilation tendency due to aquathermal expansion. The integrated conceptual geothermal model suggested a magma chamber beneath HF as the heat source, related to Oligo-Miocene volcanic activity. The breached relay ramp and fault-related open fracture system serve as pathways for geothermal fluids. Evaluation of the geothermal potential utilized volumetric calculations and Monte Carlo simulation. The estimated hot water volumes were 1.72 km3, 4.242 km3, and 5.332 km3 for the Nubian reservoir in the onshore part, Thebes reservoir in the offshore part, and Nubian reservoir in the offshore part, respectively. The results indicate a medium enthalpy resource suitable for electricity generation using a Kalina geothermal power plant. The predicted geothermal power output is promising, with an average power output of 9.64 MWe, 21.38 MWe, and 43.76 MWe for the Nubian reservoir in the onshore part, Thebes reservoir in the offshore part, and Nubian reservoir in the offshore part, respectively. These outputs can potentially supply electricity to approximately 12,000, 29,000 and 53,000 households, respectively.
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This study examined the functionalization of graphene with easily ionizable elements, such as lithium, and subsequently its interaction with the biopolymer sodium alginate (SA), to highlight its potential for biomedical applications. Utilizing Density Functional Theory (DFT), the research comprehensively investigated the structural, electronic, and spectroscopic properties of these graphene-based composites. The electronic properties of functionalized graphene were investigated using DFT at the B3LYP/6-31G(d,p) level. Among the various configurations studied, graphene exhibited weak interaction with two lithium atoms, displaying the highest reactivity in terms of total dipole moment (TDM) at 5.967 Debye and a HOMO/LUMO energy gap (ΔE) of 0.748 eV. Electrostatic potential mapping revealed that graphene when enhanced with lithium and three units of SA, exhibited an augmented potential density on its surface, a finding corroborated by other investigated physical properties. Notably, the configuration of graphene/3SA/Li, with weak interaction occurring at two side carbons, demonstrated the highest reactivity with a TDM of 15.509 Debye and ΔE of 0.280 eV. Additionally, a shift in the spectral characteristics of graphene towards lower wavenumbers was observed as lithium and SA interacted with the graphene substrate. The PDOS plot for Graphene/3SA/Li, showed the highest contribution in the HOMO orbitals was equally from lithium, sodium, hydrogen, and oxygen, while the lowest contribution was from carbon. This computational analysis provides comprehensive insights into the functionalized graphene systems, aiding in their further development and optimization for practical biomedical use.
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SUMMARY: This study assessed the effects of Acacia Senegal (AS) combined with insulin on Na+/K+-ATPase (NKA) activity and mRNA expression, serum glucose, renal function, and oxidative stress in a rat model of diabetic nephropathy (DN). Sixty rats were equally divided into six groups: normal control, normal+AS, diabetic (DM), DM+insulin, DM+AS, and DM+insulin+AS groups. Diabetes mellitus (type 1) was induced by a single injection of streptozotocin (65 mg/kg), and insulin and AS treatments were carried until rats were culled at the end of week 12. Serum glucose and creatinine levels, hemoglobin A1c (HbA1c) were measured. Renal homogenate levels of NKA activity and gene expression, malondialdehyde, superoxide dismutase (SOD), catalase and reduced glutathione (GSH) were evaluated as well as kidney tissue histology and ultrastructure. Diabetes caused glomerular damage and modulation of blood and tissue levels of creatinine, glucose, HbA1c, malondialdehyde, NKA activity and gene expression, SOD, catalase and GSH, which were significantly (p<0.05) treated with AS, insulin, and insulin plus AS. However, AS+insulin treatments were more effective. In conclusion, combined administration of AS with insulin to rats with DN decreased NKA activity and gene expression as well as oxidative stress, and improved glycemic state and renal structure and function.
Este estudio evaluó los efectos de Acacia senegal (AS) combinada con insulina sobre la actividad Na+/K+- ATPasa (NKA) y la expresión de ARNm, la glucosa sérica, la función renal y el estrés oxidativo en un modelo de nefropatía diabética (ND) en ratas. Sesenta ratas se dividieron equitativamente en seis grupos: control normal, normal+AS, diabética (DM), DM+insulina, DM+AS y DM+insulina+AS. La diabetes mellitus (tipo 1) se indujo mediante una única inyección de estreptozotocina (65 mg/kg), y los tratamientos con insulina y AS se llevaron a cabo hasta que las ratas fueron sacrificadas al final de la semana 12. Se midieron niveles séricos de glucosa y creatinina, hemoglobina A1c (HbA1c). Se evaluaron los niveles de homogeneizado renal de actividad NKA y expresión génica, malondialdehído, superóxido dismutasa (SOD), catalasa y glutatión reducido (GSH), así como la histología y ultraestructura del tejido renal. La diabetes causó daño glomerular y modulación de los niveles sanguíneos y tisulares de creatinina, glucosa, HbA1c, malondialdehído, actividad y expresión génica de NKA, SOD, catalasa y GSH, los cuales fueron tratados significativamente (p<0,05) con AS, insulina e insulina más AS. Sin embargo, los tratamientos con AS+insulina fueron más efectivos. En conclusión, la administración combinada de AS con insulina a ratas con DN disminuyó la actividad de NKA y la expresión genética, así como el estrés oxidativo, y mejoró el estado glucémico y la estructura y función renal.
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Animales , Masculino , Ratas , Extractos Vegetales/administración & dosificación , ATPasa Intercambiadora de Sodio-Potasio/efectos de los fármacos , Nefropatías Diabéticas/tratamiento farmacológico , Acacia/química , Superóxido Dismutasa , Hemoglobina Glucada/análisis , Extractos Vegetales/farmacología , Expresión Génica , Ratas Sprague-Dawley , ATPasa Intercambiadora de Sodio-Potasio/genética , Estrés Oxidativo , Microscopía Electrónica de Transmisión , Modelos Animales de Enfermedad , Quimioterapia Combinada , Control Glucémico , Insulina/administración & dosificación , Riñón/efectos de los fármacos , MalondialdehídoRESUMEN
OBJECTIVES: The present study assessed the knowledge, attitudes, and practices of physicians in Sudan regarding depression. METHODS: A cross-sectional study was conducted among physicians who practiced at public and private health facilities in Sudan in December of 2022. An online Google form questionnaire was administered that included knowledge, practice, and sociodemographic sections of the depression attitude questionnaire. The link to the questionnaire was sent to a convenience sample of physicians through a variety of methods including social media. RESULTS: A total of 407 physicians completed the questionnaire. The majority (81.1%) had no formal training on mental health after graduation. A total of 43.0% reported difficulties in differentiating between unhappiness and clinical depression, although 48.6% indicated that they could differentiate between chemical and psychological causes for depression. Half (50.4%) did not feel comfortable dealing with depressed patients. Nearly 70% indicated that psychotherapy was a better option for treating these patients than antidepressants, but only 45.7% had any mental health services at their health facility. Physicians with prior mental health training (both pre- and postgraduate training) were more likely to provide treatment options for depressed patients. CONCLUSIONS: This study indicates a moderate knowledge among physicians about depression, but also significant concern regarding poor attitudes and practices held toward the treatment of depression, and a lack of training. These findings highlight the urgent need for the training of physicians in the diagnosis and treatment of depression in Sudan.
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Depresión , Médicos , Humanos , Depresión/diagnóstico , Depresión/terapia , Conocimientos, Actitudes y Práctica en Salud , Estudios Transversales , Sudán , Actitud del Personal de Salud , Encuestas y CuestionariosRESUMEN
This spotlight article gives two clinical case examples for the implementation of a suggested safe and feasible strategy to implant leadless pacemakers instead of changing the generators of transvenous pacemakers with depleted batteries in elderly patients.
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Introduction: Pregnancy increases the risk of developing a severe illness due to COVID-19 infection. To the best of our knowledge, no previous study has been conducted on COVID-19 vaccine acceptance among pregnant women in Sudan. Hence, this study aimed to determine COVID-19 vaccination acceptance and its predictors among pregnant women. Methods: A cross-sectional study was conducted among 623 pregnant women attending Gadarif maternity hospital in eastern Sudan through a structured questionnaire. Data were obtained on sociodemographic characteristics, obstetric and health-related characteristics, COVID-19 infection, and vaccination-related information, as well as beliefs about and acceptance of COVID-19 vaccination. Results: COVID-19 vaccine acceptance among the pregnant women was 2.7%. The vaccine acceptance was higher if their husband's education was secondary school or higher [adjusted odds ratio [AOR] 4.30, 95% confidence interval (CI) 1.11-16.65, p = 0.035] and discussion of COVID-19 vaccine with the pregnant women by a health care professional in the hospital (AOR 5.46, 95% CI 1.94-15.35, p < 0.001). The most common reasons for resistance to the vaccine were concerns about the side effects of the vaccine for the mother and her baby. Conclusion: Acceptance of the COVID-19 vaccination among the pregnant women was very low. Discussions with pregnant women and their husbands by health care professionals regarding the safety of COVID-19 vaccine for the mother and her baby are highly recommended.
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Vacunas contra la COVID-19 , COVID-19 , Humanos , Femenino , Embarazo , Lactante , Vacunas contra la COVID-19/uso terapéutico , Mujeres Embarazadas , Estudios Transversales , COVID-19/prevención & control , Sudán , HospitalesRESUMEN
Purpose: Sub-Saharan Africa suffers from a dual impact of communicable (CDs) and non-communicable diseases (NCDs). There is scarce data on causes, trends of admission, and deaths among patients in Sudan. We aimed to determine the causes, trends of admission, and mortality among adult patients admitted to Gadarif Hospital in Eastern Sudan. Patients and Methods: The medical records of adult patients admitted to Gadarif medical wards from January 2017 to December 2020 were reviewed for age, gender, causes of admission, and outcomes. Multivariate Cox regression analysis was used to analysis factors (age, sex, years, and disease) associated with the mortality. Results: Of the 7230 patients who were admitted, 2221 (34.7%) were females and 5009 (69.3%) were males. The median age (interquartile range, IQR) was 47.0 (35.0) years. Of these 7230 patients, 3167 (43.8%) and 4063 (56.2%) patients were admitted with CDs and NCDs, respectively. Cardiovascular diseases (18.4%), snakebites (12.9%), and visceral leishmaniasis (12.0%) were the most common causes of admission. The overall in-patient adult deaths were 674 (9.3%). Cardiovascular diseases (22.3%), neurological diseases (16.9%), sepsis (15.9%), renal diseases (13.9%), and snakebites (8.3%) were the most common causes of inpatient mortality. Malignancy (20.7%), sepsis (20.9%), neurological diseases (17.4%), and cardiovascular diseases (13.8%) comprised the highest case fatality rates among the admitted patients. Using a Cox regression model (adjusted), age (adjusted hazard ratio = 1.02, 95% confidence interval = 1.01â1.03) was associated with increased mortality hazard. However, the gender and years of admission were not associated with increased mortality hazard. Conclusion: Admissions and mortality rates for CDs and NCDs are high compared with other African countries. Preventive measures are required to avert the high burden of these diseases. Health care systems in Sudan need to be prepared to deal with the dual burden of the diseases.
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SUMMARY: Diabetic nephropathy (DN) is the most common complication of diabetes. Several studies have been done in a trial to protect against this problem at the ultrastructure level. This study investigates the protective effect of oral administration of Acacia senegal (AS) against the development of DN. Sixty male albino rats were randomly divided into six groups: control, Acacia senegal control, Diabetic untreated, diabetic insulin-treated, Diabetic AS treated, and Diabetic insulin and AS combined treated groups. Plasma glucose, HbA1c, serum Albumin, creatinine, urine creatinine was measured using specific kits. Determinations of creatinine clearance and blood pressure were done. The renal tissues of both kidneys were prepared to investigate under both light (LM) and electron microscope (EM). Ultrastructure examination of renal rats tissue of diabetic untreated rats showed the destruction of the glomerular basement membrane and endothelial cells together with hemorrhage in glomerular capsules (Bowman's capsules). On the other side, both LM and EM revealed improving the endothelial cells and the other glomerular capsules structures, especially with the combined treated group, which confirmed the improvement of the biochemical investigation in the study. In conclusion, from the present study, using the oral AS together with SC insulin could be protected against the development of DN.
RESUMEN: La nefropatía diabética (ND) es la complicación más común de la diabetes. Se han realizado varios estudios de ensayo para abordar esta dificultad a nivel de ultraestructura. Este estudio investiga el efecto protector de la administración oral de Acacia senegal (AS) contra el desarrollo de la ND. Se dividieron sesenta ratas albinas machos aleatoriamente en seis grupos: control, control de Acacia senegal, diabéticos no tratados, diabéticos tratados con insulina, diabéticos tratados con AS y grupos tratados con compuesto de insulina diabética + AS. Se midieron utilizando kits específicos, glucosa plasmática, HbA1c, albúmina sérica, creatinina en sangre y en orina. Se registraron la creatinina y la presión arterial. Los tejidos renales de ambos riñones se prepararon para investigar tanto con microscopio óptico (MO) como electrónico (ME). El examen de la ultraestructura del tejido renal de ratas diabéticas no tratadas mostró la destrucción de la membrana basal glomerular y las células endoteliales junto con hemorragia en las cápsulas glomerulares (cápsulas de Bowman). Por otro lado, tanto MO como ME revelaron una mejora de las células endoteliales y las estructuras capsulares glomerulares, en el grupo tratado con el compuesto, lo que confirmó la mejora de la investigación bioquímica. En conclusión, el uso de AS oral en combinación con insulina podría proteger contra el desarrollo de ND.
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Animales , Ratas , Nefropatías Diabéticas/prevención & control , Acacia , Goma Arábiga/administración & dosificación , Riñón/efectos de los fármacos , Microscopía Electrónica , Biomarcadores , Administración Oral , Ratas Sprague-Dawley , Modelos Animales de Enfermedad , Riñón/ultraestructuraRESUMEN
OBJECTIVE: Many studies still dispute the identification of independent risk factors that influence outcome after neonatal cardiac surgery. We present our study to announce the contemporary outcomes and risk profile of neonatal cardiac surgery at our institute. METHODS: We designed a retrospective study of neonatal patients who underwent surgery for congenital heart diseases between June 2011 and April 2020. Demographic, operative, and postoperative data were collected from medical records and surgical databases. The primary outcome was the operative mortality (in-hospital death) and secondary outcomes included hospital length of stay, intensive care unit stay, duration of mechanical ventilation. RESULTS: In total, 1155 cardiac surgeries in children were identified; of these, 136 (11.8%) were performed in neonates. Arterial switch operations (48 cases) were the most frequent procedures. Postoperatively, 11 (8.1%) patients required extracorporeal membrane oxygenation, and 4 (2.9%) patients had complete heart block. Postoperative in-hospital mortality was 11%. The median postoperative duration of mechanical ventilation, intensive care unit stay, and hospital length of stay were 6, 18, and 24 days, respectively. CONCLUSION: The early outcomes of neonatal cardiac surgery are encouraging. The requirement of postoperative extracorporeal membrane oxygenation support, postoperative intracranial hemorrhage, and acute kidney were identified as independent risk factors of mortality following surgery for congenital heart defects in neonates.
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Cardiopatías Congénitas , Complicaciones Posoperatorias , Niño , Cardiopatías Congénitas/complicaciones , Mortalidad Hospitalaria , Humanos , Recién Nacido , Tiempo de Internación , Complicaciones Posoperatorias/etiología , Estudios Retrospectivos , Factores de Riesgo , Resultado del TratamientoRESUMEN
This study tested the protective effect of maslinic acid (MA) against diabetic retinopathy (DR) in rats with type 1 diabetes mellitus (T1DM) and investigated possible mechanisms of action. DM was introduced by streptozotocin (STZ) (65 mg/kg, i.p.). Control and STZ (T1DM) were divided into 2 subgroups, which received either the vehicle or MA (80 mg/kg). Serum, pancreases, and retinas were collected for further use. MA significantly reduced fasting glucose levels in the control and T1DM rats but enhanced fasting insulin levels and partially increased the size of the islets of Langerhans and the number of ß-cells in T1DM rats. In addition, MA significantly improved the retina structure by preventing the reduction in the area between the inner and outer limiting membranes (ILM and OLM, respectively) and increasing the number of cells forming the ganglion cell layer (GCL), inner nuclear layer (INL), and outer nuclear layer (ONL). Associated with these effects, MA significantly reduced the total levels of tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6), as well as the nuclear levels of NF-κB p65, mRNA levels of Bax, and protein levels of cleaved caspase-3 in the retinas of T1DM rats. However, MA significantly lowered levels of reactive oxygen species (ROS) and malondialdehyde (MDA) but significantly increased the nuclear levels of Nrf2, protein levels of Bcl2, and total levels of superoxide dismutase (SOD) and reduced glutathione (GSH) in the retinas of the control and T1DM rats. In conclusion, MA prevents DR by antioxidant potential mediated by the activation of Nrf2.
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BACKGROUND: Children undergoing cardiac surgery with cardiopulmonary bypass (CPB) are exposed to the risk of hormonal imbalances resulting from acute stress, which may eventually result in high postoperative mortality and morbidity. OBJECTIVE: We assessed adrenal and thyroid hormonal changes and their determinants following cardiac surgery in children and explored their prognostic value in predicting cardiac outcomes. Study Design and Methods. A prospective cohort study was conducted at King Abdulaziz University Hospital (KAUH), between 2017 and 2018. The study involved 46 children aged 14 years or younger who underwent elective cardiac surgery with cardiopulmonary bypass. Serum levels of cortisol, TSH, fT3, and fT4 were measured preoperatively and 24, 48, and 72 hours after surgery. The cardiac risk was assessed using the risk adjustment for congenital heart surgery (RACHS) scale. A composite cardiovascular outcome was analyzed as a numerical variable and calculated as the number of cardiovascular events. RESULTS: Overall, the changes in thyroid function parameters resulted in a U-shaped curve, while cortisol levels yielded a bell-shaped curve. The most significant changes occurred at 24 hours postop, including a decrease in mean TSH by 2.08 µIU/L (p < 0.001), fT3 by 2.39 pmol/L (p < 0.001), and fT4 by 2.45 pmol/L (p < 0.001) and an increase in cortisol levels by 406.48 nmol/L (p < 0.001) with respect to the baseline. Cortisol concentration peaked higher and recovered slower among patients with high cardiac risk than their counterparts. Cardiovascular outcomes were independently predicted by the extent of the decline in fT4 and TSH at 48 and 72 hours postop, with reference to the baseline, and by the cortisol level at 24 h postop, independent of the baseline, besides the RACHS category. CONCLUSION: Cardiac surgery among children yields a high adrenocortical response and a high incidence of nonthyroidal illness syndrome, increasing cardiovascular risk. A preventive management strategy involves improving surgical techniques to minimize trauma-related stress.
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CONTEXT: Transforming growth factor-ß1 (TGF-ß1), endothelin-1 and angiotensin II are responsible for extracellular matrix accumulation within the kidney in diabetic nephropathy. OBJECTIVE: This study evaluated the effect of adding Gum Arabic (GA) and insulin on serum glucose, renal function, TGF-ß1, endothelin-1, and angiotensin II in rats with diabetic nephropathy. METHODS: Sixty male Sprague-Dawley rats were divided into; normal, normal plus GA, diabetic rats (DM), DM plus insulin, DM plus GA, and DM plus insulin plus GA groups. Levels of glucose and creatinine in serum, TGF-ß1, angiotensin II, and endothelin-1 in renal homogenate and HbA1c were measured. RESULTS: Serum creatinine, TGF-ß1, angiotensin II, and endothelin-1 were increased in diabetic rats. GA decreased serum glucose, TGF-ß1, angiotensin II, endothelin-1, and HbA1c in diabetic rats. GA and insulin decreased serum glucose, creatinine, TGF-ß1, angiotensin II, endothelin-1, and HbA1c in diabetic rats. CONCLUSION: Co-administration of GA with insulin to rats with diabetic nephropathy improved the glycemic state, renal function, TGF-ß1, endothelin-1, and angiotensin II.
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Acacia , Diabetes Mellitus Experimental , Nefropatías Diabéticas , Insulinas , Masculino , Ratas , Animales , Factor de Crecimiento Transformador beta1 , Creatinina , Angiotensina II/farmacología , Diabetes Mellitus Experimental/complicaciones , Endotelina-1 , Goma Arábiga/farmacología , Hemoglobina Glucada , Senegal , Ratas Sprague-Dawley , Riñón , Glucosa/farmacología , Insulinas/farmacologíaRESUMEN
Ascending thoracic aortic aneurysms are rare in childhood and typically are seen in the setting of connective tissue defect syndromes. These aneurysms may lead to rupture, dissection, or valvular insufficiency, so root replacement is recommended. Here, we present a 17-month-old girl who presented with fever, cough, and pericardial effusion. Initially, we suspected this could be a COVID-19 case, so a nasopharyngeal swap was performed. An ascending aorta aneurysm involving the aortic arch was confirmed by echo, and urgent ascending aorta and arch replacement were done by utilizing the descending aorta as a new arch. The final diagnosis came with cutis laxa syndrome. In similar cases, good outcomes can be achieved with accurate diagnosis and appropriate surgical management.
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Aorta Torácica/cirugía , Aneurisma de la Aorta/complicaciones , Aneurisma de la Aorta/cirugía , Cutis Laxo/complicaciones , Aneurisma de la Aorta/diagnóstico por imagen , COVID-19/diagnóstico , Tos/etiología , Diagnóstico Diferencial , Ecocardiografía , Femenino , Fiebre/etiología , Humanos , Lactante , Derrame Pericárdico/etiología , Radiografía Torácica , SARS-CoV-2 , SíndromeRESUMEN
BACKGROUND: Pericardial patches are often used for repair of congenital cardiac defects. The aim of this study was to describe our initial experience with the use of equine pericardium and its safety and advantages and disadvantages compared to bovine pericardium. METHODS: We designed a retrospective cohort study of 111 patients who were surgically treated for congenital heart disease between 2017 and 2020. Equine pericardium was used in 58 patients and bovine pericardium was used in 53 patients. Recorded variables included demographic data, preoperative cardiac pathology, site of patch insertion, morbidity and mortality. RESULTS: The overall survival rate was 94.5% and no deaths were related to patch insertion. None of our patients were reoperated on for patch related complications. Postoperative transcatheter intervention was needed in 2 patients (1.8%): one for dilatation of aortic arch stenosis after repair of hypoplastic left heart syndrome with equine pericardium and one for dilatation of pulmonary artery branches after repair of tetralogy of Fallot using bovine pericardium. CONCLUSIONS: Equine pericardium is a safe patch material for reconstruction in congenital heart surgery. It may be preferable to bovine pericardium in cases requiring a complex shape or a pliable patch as in in arch reconstruction or for valve reconstruction.
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Aorta Torácica/cirugía , Bioprótesis , Procedimientos Quirúrgicos Cardíacos/métodos , Cardiopatías Congénitas/cirugía , Síndrome del Corazón Izquierdo Hipoplásico/cirugía , Pericardio/cirugía , Adolescente , Adulto , Animales , Bovinos , Niño , Preescolar , Femenino , Caballos , Humanos , Lactante , Recién Nacido , Masculino , Procedimientos de Cirugía Plástica , Reoperación , Estudios Retrospectivos , Tasa de Supervivencia , Adulto JovenRESUMEN
Traffic congestion is monotonically increasing, especially in large cities, due to rapid urbanization. Traffic congestion not only deteriorates traffic operation and degrades traffic safety, but also imposes costs to the road users. The concerns associated with traffic congestion increase when considering more complicated situations such as unsignalized intersections and driveways at which maneuvers are entirely dependent upon drivers' judgment. Urban arterials are characterized by closely spaced signalized and unsignalized intersections and high traffic volumes, which make them a priority while analyzing traffic safety and operation. Autonomous Vehicles (AV) provide ample opportunities to overcome the aforementioned challenges. In essence, this study evaluates the impact of various AV Market Penetration Rates (MPR) on the safety and operation of urban arterials in proximity of a driveway under different traffic levels of service (LOS). Twenty-four separate scenarios were developed using VISSIM, considering six AV MPRs of 0 %, 10 %, 25 %, 50 %, 75 %, and 100 %, and four LOS including A, B, C, and D. Various operational and safety measures were analyzed including traffic density, traffic speed, traffic conflict (rear-end and lane-changing), and driving volatility. The trajectory and lane-based analysis of the traffic density indicates that MPR significantly improves the overall traffic density for all the scenarios, especially under high traffic LOS. Additionally, by increasing the MPR and decreasing the traffic volume of the network, the mean speed increases significantly by up to 6 %. Exploring the safety of the scenarios indicates that by increasing the MPR from 0% to 100 % for all the LOS, the number of rear-end conflicts and lane-changing conflicts decreases 84 %-100 % and 42 %-100 %, respectively. Moreover, assessing the longitudinal driving volatility measures, which represent risky driving behaviors, showed that higher MPRs significantly reduce some of the driving volatility measures and enhance safety.
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Accidentes de Tránsito/estadística & datos numéricos , Conducción de Automóvil/estadística & datos numéricos , Automóviles/estadística & datos numéricos , Planificación de Ciudades , Planificación Ambiental , Robótica/estadística & datos numéricos , Seguridad/estadística & datos numéricos , Accidentes de Tránsito/prevención & control , HumanosRESUMEN
Chinese herbal medicine is widely used globally. In many instances, it is associated with severe adverse outcomes. We report case of a Chinese herbal nephropathy occurring in a 43-year-old woman showing renal impairment, metabolic acidosis, Stokes - Adams syndrome, hypernatremia, and hypokalemia, characteristics not usually encountered in published cases.
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Acidosis/inducido químicamente , Síndrome de Adams-Stokes/inducido químicamente , Medicamentos Herbarios Chinos/efectos adversos , Fármacos para la Fertilidad Femenina/efectos adversos , Hipernatremia/inducido químicamente , Hipopotasemia/inducido químicamente , Enfermedades Renales/inducido químicamente , Riñón/efectos de los fármacos , Acidosis/diagnóstico , Acidosis/fisiopatología , Acidosis/terapia , Síndrome de Adams-Stokes/diagnóstico , Síndrome de Adams-Stokes/fisiopatología , Síndrome de Adams-Stokes/terapia , Adulto , Femenino , Humanos , Hipernatremia/diagnóstico , Hipernatremia/fisiopatología , Hipernatremia/terapia , Hipopotasemia/diagnóstico , Hipopotasemia/fisiopatología , Hipopotasemia/terapia , Riñón/fisiopatología , Enfermedades Renales/diagnóstico , Enfermedades Renales/fisiopatología , Enfermedades Renales/terapia , Resultado del TratamientoRESUMEN
Background: Sternal wound complications pose a tremendous challenge post-cardiac surgery. There's no consensus or clear guidelines to deal with them. We propose that simple and more objective classification helps to organize the range of sternal wound complications and suggest a relevant treatment strategy. Methods: One-hundred-sixteen cases of sternal wound complications retrospectively were reviewed out of 2,391 adult patients, who underwent full sternotomy during cardiac surgery from 2006 to 2018. Eighty-six cases conservatively were managed and the remaining 30 cases required surgical intervention. More objective classification was proposed and less invasive fasciocutaneous flap was considered for nearly all reconstructive procedures. Results: The incidence of sternal wound complications was 4.8%. Conservative management was adopted for 86 cases, mean duration was 11.19 ± 9.8 days. Surgical management was performed in 30 patients (25.86%); 28 (93.3%) of whom recovered with good outcomes with less invasive fasciocutaneous flap done for 13 cases. Two cases had recurrence; one conservatively was managed and other was reoperated and healed well. The most common organisms in recurrent infections were N. coagulase (29.8%), Klebsiella (12.5%), pseudomonas (10.5%), and MRSA (10.5%). We had 4 mortalities. None of the mortalities were related to sternal wound complications; one was related to the cardiac surgery. Conclusions: Sternal wound complications are grave events. Objective classification and proper management selection will gain better outcomes.
Asunto(s)
Esternotomía/efectos adversos , Dehiscencia de la Herida Operatoria/clasificación , Dehiscencia de la Herida Operatoria/cirugía , Infección de la Herida Quirúrgica/clasificación , Infección de la Herida Quirúrgica/cirugía , Anciano , Procedimientos Quirúrgicos Cardíacos/efectos adversos , Tratamiento Conservador , Femenino , Humanos , Masculino , Persona de Mediana Edad , Reoperación , Estudios Retrospectivos , Colgajos Quirúrgicos , Dehiscencia de la Herida Operatoria/diagnóstico , Infección de la Herida Quirúrgica/diagnósticoRESUMEN
BACKGROUND: Delayed sternal closure commonly is used after pediatric cardiac surgery. Its benefits include relieving cardiac compression and stabilizing postoperative critically ill patients. METHODS: We retrospectively reviewed the records of 72 patients, who had undergone delayed sternal closure, among 1,254 patients operated for congenital heart diseases. Indications of delayed sternal closure, perioperative hemodynamic and metabolic status, postoperative infection, and mortality were reported. RESULTS: Transposition of great arteries was the most common preoperative cardiac pathology (26.3%). Bleeding and hemodynamic instability were the most frequent indications for delayed sternal closure, representing 38.8% and 34.7%, respectively. The mean duration of open chest was 3.45 days ± 1.46 days. The mean duration of ICU stay was 20.95 days ± 20.06 days. Two patients had deep sternal wound infection. Sepsis was found in 39 patients (54.1%), and the most common causative organism was coagulase negative (30.5%). ICU stay was a significant risk factor for sepsis (P = .003); duration of open sternum, period of mechanical ventilation (MV), and total hospital stay were not statistically significant risk factors. Sternal closure time (SCT) was affected by period of hemodynamic instability (P = .036). Bypass time, clamping time, and nonsurgical bleeding did not significantly affect SCT. The mortality rate was 15.2% (N = 11). CONCLUSION: Delayed sternal closure is a simple and effective technique that could prevent postoperative cardiac compression in hemodynamic instability states after pediatric cardiac operations.